Exercise After Surgery

Surgery is usually the first line of attack against breast cancer. There are three main types of surgery for breast cancer: lumpectomy, which removes only the cancer tumor and some surrounding tissue and possibly some lymph nodes; mastectomy, which removes the whole breast and usually some lymph nodes; and lymph node removal, which may be done along with mastectomy or lumpectomy, during biopsy, or before or after any of the other types of surgery. There are two types of lymph node removal: axillary, which generally removes between five and 30 nodes, and sentinel, which removes the one or two lymph nodes closest to the cancer.

If you have an exercise routine, stick to it up to the time of your surgery. You may want to talk to a physical therapist and a certified personal trainer with breast cancer survivor experience before your surgery about how to get back to your routine once you have your doctor’s OK. Any experts guiding your exercise should be well versed in the signs and symptoms of lymphedema. It’s likely that you can do many of the same exercises you were doing before surgery, but at a lower intensity level.

How soon can you exercise after surgery?

Allow yourself enough time to heal after surgery. Your doctor or nurse will show you basic physical therapy exercises you can start the day after your surgery to maintain your arm and upper body mobility as you heal.

As for exercise routines you did before surgery, some exercises shouldn’t be done until any drains and stitches are removed. You may need 8 or more weeks before you can do that type of exercise, especially if you’ve had mastectomy with many lymph nodes removed. Several nerves run through the chest and underarm area and may be affected by breast cancer surgery, so you may find your muscles are weaker than they were before surgery.

If you’re experiencing extreme fatigue, anemia (low red blood cell count), or a lack of muscle coordination (ataxia), don’t exercise. It’s also a good idea to skip aerobic exercise if your platelet (small blood components that help the clotting process) count is lower than 50,000 per microliter of blood or your white blood cell count is lower than 3,500 per microliter of blood.

Make sure you have your surgeon’s/doctor’s OK to start. Explain the exercises you plan to do and ask about any possible limitations. It’s also a good idea to visit a physical therapist well-versed in lymphedema for a structural evaluation before you start exercising. Besides looking for lymphedema, a physical therapist can check for any other issues unrelated to breast cancer that may limit your ability to exercise. Learn how to find a lymphedema therapist.

Exercises that improve shoulder and arm mobility usually can be started a few days after surgery. Exercises to improve arm strength come later.

During the first 3 to 7 days after surgery, the American Cancer Society recommends:

Using the arm on the same side as surgery as you normally do when you bathe, comb your hair, get dressed, and eat.

Lying down and raising the arm on the same side as the surgery above heart level for 45 minutes 2 or 3 times a day. You can do this by putting your arm on pillows so your hand is higher than your wrist and your elbow is slightly higher than your shoulder. This can help ease any swelling you have after surgery.

Exercising the arm on the same side as your surgery when it’s raised above heart level by opening and closing your hand 15 to 20 times. Then bend and straighten your elbow. Do this 3 to 4 times a day. This helps ease swelling by pumping lymph fluid out of the arm.

Practice deep breathing using your diaphragm (the muscle under your navel) at least 6 times a day. Lie on your back and breathe in slowly. Keep slowly breathing in as much air as you can while trying to expand your diaphragm (push your navel out away from your spine). When you can’t breathe in any more air, relax and breathe out all the air. Do this 4 or 5 times. Deep breathing helps maintain normal chest movement, which makes it easier for your lungs to work.

Many physical therapists recommend daily stretching exercises for women who’ve had breast cancer surgery to help stop scar tissue from building up, which can limit your shoulder’s range of motion.

Once you have your doctor’s OK, you may want to consider starting with walking. Walking is an easy cardio exercise that gets your body moving. No matter what type of exercise you do, start at a light intensity level and up the intensity level very gradually.

Precautions: If you have any shortness of breath, pain, or tightness in your chest, stop exercising immediately. Tell your doctor what happened and work with him or her to develop a plan of movements that are right for you.

If you have any changes in your arm, hand, trunk, breast, or shoulder, including swelling, stop doing upper body exercises and see your doctor or lymphedema specialist. If you’ve been diagnosed with lymphedema after breast cancer surgery, there are precautions you should take before you exercise. These precautions include wearing a well-fitted compression garment or possibly wearing protective gloves. Learn more about exercise and lymphedema in the Lymphedema section.

If you’re going to do strength exercises after surgery, it’s best to work out with a certified trainer who has experience designing exercise plans for breast cancer survivors. Start with very low weights/resistance and increase very slowly.

Exercise after reconstruction

Breast reconstruction is surgery to rebuild the breast. Breast reconstruction takes place during or after mastectomy or lumpectomy. During reconstruction, a plastic surgeon creates a breast shape using an implant, tissue from another place on your body, or both.

Like exercise after surgery to remove breast cancer, you need to give yourself enough time to heal after reconstruction before you start. If you have reconstruction that moves skin, fat, and sometimes muscle from another area of your body (belly, back, buttocks, or thigh) to rebuild your breast, you’ll probably need more than 8 weeks to heal.

In many cases, your surgeon may want you to start doing gentle stretching exercises, such as shoulder rolls or arm circles 2 or 3 days after surgery. Until you have your surgeon’s OK, don’t do any strenuous exercise such as high-impact aerobics, jogging, swimming, or lifting weights. And before you start doing any other exercise, make sure you tell your surgeon what you plan to do and get her or his OK.

The recommendations for specific exercises after reconstruction depend on the type of reconstruction you’ve had. Your surgeon will give you information and examples of gentle stretching exercises and tell you when to start doing the stretches.

It’s also a good idea to visit a physical therapist trained in diagnosing lymphedema for a structural evaluation before you start exercising. Besides looking for lymphedema, a physical therapist can check for any other issues unrelated to breast cancer that may limit your ability to exercise. You also may want to visit a physical therapist if you have trouble or feel pain while doing any of the gentle stretching your surgeon recommends. Learn how to find a lymphedema therapist.

Implant reconstruction

If you have a tissue expander in (a temporary inflatable implant that stretches the skin to make room for the final implant), you can usually start gentle shoulder stretching exercises about 2 weeks after surgery once your mastectomy scar has started to heal. Many physical therapists recommend doing these stretches right after a warm shower because the muscles and skin are more flexible.

TRAM flap reconstruction

TRAM stands for the transverse rectus abdominis muscle, which is located in the lower abdomen, between the waist and the pubic bone. A TRAM flap uses a part of this muscle, its blood vessels, and some belly fat to rebuild the breast.

After TRAM flap surgery, you can start walking the next day, though it will probably hurt because of the incision in your abdomen. For the first two days, many physical therapists recommend women do calf exercises and deep breathing exercises to help prevent blood clots. You can start arm rehabilitation exercises 3 or 4 days after surgery.

Once the drains are removed, you can start stretching your chest, shoulders, and arms. It’s also a good idea to walk regularly as you recover.

Don’t do any abdominal (“abs”) exercises until about 6 weeks after surgery or whenever your surgeon says it’s OK to start. Start slowly and gently while continuing your stretching exercises and walking or other low-intensity aerobic exercise.

Latissimus dorsi flap reconstruction

The latissimus dorsi is the muscle below the shoulder and behind the armpit. A latissimus dorsi flap uses an oval section of this muscle, skin, and fat to rebuild the breast.

Because this type of reconstruction affects the shoulder muscle, you should wait to start any gentle shoulder stretching until about 2 weeks after surgery. Wait until about 3 months after surgery to do any resistance/strength exercises.

If you have any shortness of breath, pain, or tightness in your chest, stop exercising immediately. Tell your doctor what happened and work with him or her to develop a plan of movements that are right for you.

DIEP flap reconstruction

DIEP stands for deep inferior epigastric perforator. In a DIEP flap, fat, skin, and blood vessels, but no muscle at all, are cut from the wall of the lower belly and moved up to your chest to rebuild your breast. Because no muscle is used, most women recover more quickly and have a lower risk of losing abdominal muscle strength with a DIEP flap compared to a TRAM flap.

After DIEP flap surgery, you can start walking the next day, though it will probably hurt because of the incision in your abdomen. For the first 2 days, many physical therapists recommend women do calf exercises and deep breathing exercises to help prevent blood clots. You can start arm rehabilitation exercises 3 or 4 days after surgery.

Once the drains are removed, you can start stretching your chest, shoulders, and arms. It’s also a good idea to walk regularly as you recover.

Don’t do any abdominal (“abs”) exercises until about 6 weeks after surgery or whenever your surgeon says it’s OK to start. Start slowly and gently while continuing your stretching exercises and walking or other low-intensity aerobic exercise.